Revisiting the Utility of U.S. Medical Licensing Examination Step 3
Authors: William B. Earle, Lauren O’Loughlin, C. Christopher Smith
Journal: Annals of Internal Medicine (2023)

Ideas and OpinionsJuly 2023Revisiting the Utility of U.S. Medical Licensing Examination Step 3William B. Earle, MD, Lauren O’Loughlin, MD, and C. Christopher Smith, MDWilliam B. Earle, MDDepartment of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (W.B.E., L.O., C.C.S.)., Lauren O’Loughlin, MDDepartment of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (W.B.E., L.O., C.C.S.)., and C. Christopher Smith, MDDepartment of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (W.B.E., L.O., C.C.S.).Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-0695 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail As medical practice has become more specialized, the U.S. Medical Licensing Examination (USMLE) Step 3 has become outdated. In recent years, there have been substantial changes to the USMLE Step examinations, with Step 1 transitioning to pass/fail scoring and the elimination of Step 2 Clinical Skills. These changes bring us to a unique time of reflection on the purpose and structure of Step 3. Considering its history and aims within the current landscape of medical practice and licensure, we believe that the present structure of Step 3 is impractical and burdensome.The current USMLE 3-step examination structure was introduced in ...References1. Kies S, Shultz M. Proposed changes to the United States Medical Licensing Examination: impact on curricula and libraries. J Med Libr Assoc. 2010;98:12-6. [PMID: 20098646] doi:10.3163/1536-5050.98.1.007 CrossrefMedlineGoogle Scholar2. Melnick DE, Dillon GF, Swanson DB. Medical licensing examinations in the United States. J Dent Educ. 2002;66:595-9. [PMID: 12056763] CrossrefMedlineGoogle Scholar3. Dalen JE, Ryan KJ, Alpert JS. Where have the generalists gone? They became specialists, then subspecialists [Editorial]. Am J Med. 2017;130:766-768. [PMID: 28216448] doi:10.1016/j.amjmed.2017.01.026 CrossrefMedlineGoogle Scholar4. Bruns SD, Davis BR, Demirjian AN, et al; Society for Surgery of Alimentary Tract Resident Education Committee. The subspecialization of surgery: a paradigm shift. J Gastrointest Surg. 2014;18:1523-31. [PMID: 24756925] doi:10.1007/s11605-014-2514-4 CrossrefMedlineGoogle Scholar5. Densen P. Challenges and opportunities facing medical education. Trans Am Clin Climatol Assoc. 2011;122:48-58. [PMID: 21686208] MedlineGoogle Scholar6. United States Medical Licensing Examination. Performance data. 2022. Accessed at www.usmle.org/performance-data on 27 June 2022. Google Scholar7. Association of American Medical Colleges. 2022 results of the AAMC Survey of Resident/Fellow Stipends and Benefits. November 2022. Accessed at www.aamc.org/data-reports/students-residents/report/aamc-survey-resident/fellow-stipends-and-benefits on 28 April 2023. Google Scholar8. Raimo J, LaVine S, Spielmann K, et al. The correlation of stress in residency with future stress and burnout: a 10-year prospective cohort study. J Grad Med Educ. 2018;10:524-531. [PMID: 30386477] doi:10.4300/JGME-D-18-00273.1 CrossrefMedlineGoogle Scholar9. Lipner RS, Brossman BG, Grosso LJ. Changes to the American Board of Internal Medicine’s Maintenance of Certification program: preserving core assessment values. Journal of Applied Testing Technology. 2019;20:11-20. Google Scholar Author, Article, and Disclosure InformationAuthors: William B. Earle, MD; Lauren O’Loughlin, MD; C. Christopher Smith, MDAffiliations: Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (W.B.E., L.O., C.C.S.).Disclosures: Authors have reported no disclosures of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-0695.Corresponding Author: William B. Earle, MD, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215; e-mail, [email protected].harvard.edu.Author Contributions: Conception and design: W.B. Earle, L. O’Loughlin, C.C. Smith.Analysis and interpretation of the data: L. O’Loughlin.Drafting of the article: W.B. Earle, L. O’Loughlin, C.C. Smith.Critical revision of the article for important intellectual content: W.B. Earle, L. O’Loughlin, C.C. Smith.Final approval of the article: W.B. Earle, L. O’Loughlin, C.C. Smith.Administrative, technical, or logistic support: W.B. Earle.Collection and assembly of data: L. O’Loughlin.This article was published at Annals.org on 20 June 2023. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Current IssueJuly 2023Volume 176, Issue 7Page: 989-990KeywordsGraduate medical educationPrimary care physiciansResidency ePublished: 20 June 2023 Issue Published: July 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...